2010 Clinical Revisions

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InterQual

®

Guidelines for Surgery and Procedures

Performed in the Inpatient Setting

2010 Clinical Revisions

Criteria Evidence Review and Update

McKesson Health Solutions is committed to keeping the InterQual product suite current and accurate. Criteria are continually reviewed and updated, with new editions of every product released annually. McKesson Health Solutions’ staff of physicians, nurses, and other licensed healthcare professionals and its extensive array of primary care and specialty consultants participate in ongoing criteria revision as new medical information emerges. Each annual release of the criteria reflects a thorough review of the most recent evidence-based medical literature, society guidelines, current practice standards, and incorporation of consultant and user feedback.

Organization and Features

New Format for Clinical Revisions

The Clinical Revisions have been redesigned to provide greater ease of use for criteria users. Criteria-specific changes are presented in table format, allowing the details of each change to be more easily identified.

Scope of Clinical Revisions

The Clinical Revisions provide details of changes to InterQual Clinical Criteria. They do not provide information on changes made to CareEnhance® _{Review Manager software.}

For information on Review Manager software changes, see the Review Manager Release Notes and the What's New topic in CareEnhance Review Manager Help.

General Changes

The introduction page has been rewritten to help our clients better understand the guidelines. The introduction page now appears as:

McKesson strongly recommends that this list be reviewed and approved at an organizational level before it is instituted. It is imperative to note that McKesson’s Guidelines for Surgery and Procedures in the Inpatient Setting is

not designed to be all-inclusive and does not necessarily align with CMS guidelines on inpatient settings.

McKesson Health Solutions’ Guidelines for Surgery and Procedures in the Inpatient Setting was developed to assist clients in determining when a procedure might be appropriate for the inpatient setting. A procedure is designated as inpatient when admission to the hospital with a planned postoperative stay of ≥ 24 hours is required. The decision to admit a patient remains the responsibility of the treating provider. Determination of the appropriate setting for a surgical patient (inpatient versus outpatient) is a clinical decision best made with consideration of multiple clinical factors

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including, but not limited to, type of procedure planned, urgency, hemodynamic stability, comorbidities, and the likelihood of complications. This might differ based upon legislative and geographic variances and might impact organizational policy. Documentation of the patient’s clinical condition is essential to ensure the appropriate setting and level of care required. Patients experiencing complications during an outpatient procedure might require admission. Appropriate admission criteria for these patients can be found in the InterQual® Acute Level of Care Criteria.

Procedures and interventions listed in these guidelines are organized alphabetically by surgical specialty (e.g., General Surgery, Orthopedics, Vascular Surgery) into two groups. The first group includes procedures and interventions for which InterQual Procedures Criteria are available to support the medical necessity and the inpatient setting designation. The second group includes procedures and interventions that are not addressed by InterQual Procedures Criteria.

Organizations that follow the Center for Medicare and Medicaid Services (CMS) inpatient designations can find a link to the CMS Inpatient Only List (Addendum E) on the MHS Customer Hub, (http://MHScustomerhub.mckesson.com) in the Documents section by clicking "Documents" and then searching for the keyword “inpatient.”

Interpreting the Guidelines

Qualifiers have been added to certain procedures to specify when that procedure is appropriate for the inpatient setting.

Qualifiers Example

Certain approaches, age restrictions, or conditions make a procedure appropriate for the inpatient setting.

Salpingectomy (Open) – Open removal of the fallopian tube is appropriate for the inpatient setting, while laparoscopic salpingectomy can be safely performed in the outpatient setting.

Urgent procedures are those that must be performed immediately due to the severity of the patient’s symptoms or findings.

Percutaneous Coronary Intervention (PCI): Urgent –

Unscheduled, urgent coronary angioplasty, stent insertion, or atherectomy is appropriate for the inpatient setting for acutely

symptomatic patients. Those

undergoing the procedure electively (not urgently) can be safely discharged to home when clinically stable.

An asterisk “*” next to a procedure indicates that due to variations in practice, the procedure may be performed in the outpatient setting.

Meckel’s Diverticulum Excision (Open / Laparoscopic*) – In this example the open procedure is appropriate for the inpatient setting, but when performed laparoscopically it may be either inpatient or outpatient due to variations in practice.

When a procedure is “also known as” (AKA) another name, or if a different procedure will produce the same generic result, the additional procedure name is italicized and

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indented beneath the original. For example: “Total Joint Replacement: Hip” is also known as “Arthroplasty, Total, Hip”.

Procedures in the Pediatric category have been specifically reviewed or evaluated for pediatric indications. Other procedures in the guidelines may also be appropriate for the pediatric population.

The guidelines have been reformatted to more closely follow the McKesson Procedures Criteria.

• The guidelines are now organized as surgical specialty categories. The following crosswalk should aide the user in locating procedures in the 2010 category:

2009 Category 2010 Categories Cardiac Cardiac Cardio-Thoracic Transplant Endocrine Cardio-Thoracic General

Oro-Maxillo-Facial & Otolaryngology Eye, Ear, Nose, Throat Cardio-Thoracic

Oro-Maxillo-Facial & Otolaryngology Pediatric Gastrointestinal Cardio-Thoracic General Pediatric Genitourinary General Pediatric Transplant Urology Hematologic and Lymphatic General

Transplant

Musculoskeletal Hand, Plastic & Reconstructive Neurologic & Spine

Oro-Maxillo-Facial & Otolaryngology Orthopedic:

Upper & Lower Extremity Upper Extremity

Lower Extremity Pediatric

Nervous System Hand, Plastic & Reconstructive Neurologic & Spine

Obstetric / Gynecologic Obstetric / Gynecologic Skin / Connective Tissue General

Hand, Plastic & Reconstructive

Thoracic Cardio-Thoracic General

Vascular Hand, Plastic & Reconstructive

Vascular

• A new category has been created for procedures with pediatric specific indications. This does not mean that other procedures in the guidelines are not appropriate for the pediatric population, only that these procedures have been specifically reviewed or evaluated for pediatric indications.

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• Strings of related procedures previously separated by a “/” have been separated from each other and alphabetized within their category to make them easier to find.

• Procedures were added to the guidelines to correlate with the addition of InterQual Procedures Criteria (first group only).

• Client requests for additional procedures deemed appropriate for the inpatient setting by McKesson’s surgical consultants were added (second group only).

• Modifications were made to some procedures to more closely mirror InterQual Procedures Criteria naming conventions.

• Modifiers were added to some procedures to clarify which specific indications are necessary for the procedure to be appropriate for the inpatient setting.

• Procedures were removed from the guidelines if no longer considered appropriate for the inpatient setting based on InterQual Procedures Criteria or feedback from McKesson’s surgical consultants.

• Some procedures were removed from the guidelines because they were redundant to others that remain in the guidelines.

The following procedures have been added to the InterQual 2010 Guidelines for Surgery and Procedures in the Inpatient Setting:

Arthroplasty: Elbow Wrist Biopsy:

Brain

Nerve Root Tumor Spinal Cord Tumor

Electrophysiological (EP) Testing: Urgent

Embolectomy / Thrombectomy, Peripheral Artery:

Embolectomy, Peripheral Artery, +/- Repair +/- Graft Thrombectomy, Peripheral Artery, +/- Repair +/- Graft

Endarterectomy / Bypass, Renovascular:

Aortorenal Hepatorenal Splenorenal

Gastric Stimulation:

Gastric Pacing / Pacemaker Insertion

Herniorrhaphy: (Incarcerated only) Inguinal, (Laparoscopic / Open) Umbilical

Patellectomy Pedicle Flap

Video Electroencephalographic (EEG) Monitoring

The following procedures have been removed from the InterQual 2010 Guidelines for Surgery and Procedures in the Inpatient Setting:

AC Separation (AC ligament) Repair, Shoulder (Open) Acromioplasty, Shoulder (Open)

Annular Ligament Tear Repair, Elbow (Open) Arthrodesis, Wrist

Arthrotomy: Shoulder: Dislocation and Unable to Reduce by Closed Procedure Discectomy, Lumbar

Dislocation Reduction, Shoulder (Open) Heel Cord Lengthening*

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The following procedures have been removed from the InterQual 2010 Guidelines for Surgery and Procedures in the Inpatient Setting (cont):

Laparoscopic Supracervical Hysterectomy (LSH) Lumpectomy

Mammoplasty, Reduction, Female

Medial and Lateral Ligaments Repair, Elbow (Open) Percutaneous Coronary Intervention (PCI): DCA Prostatectomy:

Transurethral*

Transurethral Holmium Laser Resection / Enucleation Replantation, Hand

Stereotactic Radiosurgery: Brain; Skull Base Thrombolysis: Vascular Access Device*

Triceps Tendon Insertion Repair, Elbow (Open) Uterine Artery Embolization (UAE)*

The following procedures have been modified for the InterQual 2010 Guidelines for Surgery and Procedures Performed in the Inpatient Setting. They are organized into their new

surgical categories:

2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Cardiac

Biventricular Pacemaker - Implantable Cardioverter Defibrillator (ICD)

(Combination Device Insertion)

Category: Cardiac

Biventricular Pacemaker Insertion:

Cardiac Resynchronization Therapy (CRT)

Category: Cardiac

Excision: Pericardial Cyst / Tumor; External / Intra Cardiac Tumor

Category: Cardio-Thoracic Excision:

External / Intra cardiac Tumor Pericardial Cyst / Tumor (Moved to second group) Category: Thoracic

Excision, Esophageal Lesion: Tracheal Stenosis / Tumor

Category: Cardio-Thoracic

Excision, Esophageal Lesion / Tumor Tracheal Stenosis Repair

Category: Gastrointestinal Hiatal Hernia Repair / Antireflux

Surgery: Belsey Repair Fundoplication Hill Repair Nissen Repair Thal-Nissen Repair Category: Cardio-Thoracic

Antireflux Surgery / Hiatal Hernia Repair:

Belsey's Wrap Collis Gastroplasty Dor Fundoplication Hill's Gastropexy Nissen Fundoplication Rosetti Fundoplication Thal-Nissen Repair Toupet Fundoplication Laparoscopic Open Category: Thoracic

Lung Biopsy (Open) Category: Cardio-Thoracic Lung Biopsy (Open) (Moved to second group)

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Thoracic

Myotomy: Cricopharyngeal; Epiphrenic (Open)

Myotomy, Cricopharyngeal: (Open)

Zenker's Diverticulum Resection / Repair

Zenker's Diverticulectomy Zenker's Diverticulopexy Zenker's Diverticulostomy Category: Thoracic

Myotomy: Cricopharyngeal; Epiphrenic (Open)

Category: Cardio-Thoracic Myotomy, Epiphrenic:

Epiphrenic Diverticulectomy

Category: Cardiac

Pericardiectomy Category: Cardio-Thoracic Pericardiectomy: Open

Percutaneous Subxiphoid Category: Thoracic

Pleurectomy Category: Cardio-Thoracic Pleurectomy (Moved to second group) Category: Musculoskeletal

Reduction / Resection / Debridement: Sternum

Category: Cardio-Thoracic Sternal Reduction / Resection / Debridement

Category: Cardiac Repair:

Atrial Septal Defect (ASD), +/- Prosthesis / Tissue Graft Ventricular Septal Defect (VSD)

Atrial Septal Defect (ASD) Repair (Open) Ventricular Septal Defect (VSD) Repair (Open)

Category: Thoracic

Thoracic Aneurysm Repair

Thoracic / Thoracoabdominal Aortic Aneurysm Repair

Category: Cardiac

Valve Replacement / Repair / Revision Category: Cardio-Thoracic Aortic Valve Replacement (AVR)

Mitral Valve Replacement (MVR) / Repair Tricuspid Valve Replacement (TVR) /

Resection / Repair Category: Cardiac

Valvuloplasty Category: Cardio-Thoracic Aortic Valvuloplasty, Percutaneous Balloon and Aortic Stenosis (AS) with High Surgical Risk

Mitral Valvuloplasty, Percutaneous Balloon Category: Gastrointestinal

Bariatric Surgery:

Gastric Stapling, +/- Bypass Lap Band Gastric Banding* Roux-en-Y Gastric Bypass

(RYGB)

Category: General Bariatric Surgery:

Biliopancreatic Diversion with Duodenal Switch

Roux-en-Y Gastric Bypass (RYGB) Sleeve Gastrectomy

Weight Loss Surgery

Category: Gastrointestinal

Cholecystoenterostomy Category: General Cholecystoenterostomy (Moved to second group)

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Gastrointestinal Colectomy:

Hartman Pouch Procedure Hemicolectomy / Partial Colectomy

Low Anterior Resection Proctocolectomy

Sigmoidectomy / Sigmoid resection

Subtotal Colectomy, + Ileostomy Total Colectomy, + Ileostomy (e.g., Ileal-Anal / Ileal-Rectal Pouch Anastomosis)

Category: General Colectomy:

Left:

Left Hemicolectomy Left Partial Colectomy Low Anterior Resection Sigmoid Colectomy Sigmoidectomy

Right:

Right Hemicolectomy Right Partial Colectomy

Subtotal Colectomy, + Ileostomy Total Colectomy, + Ileostomy:

Continent Ileostomy with Total Colectomy

Ileo-Anal Pouch Anastomosis with Total Colectomy

Ileo-Rectal Anastomosis with Total Colectomy

Proctocolectomy, Total, with Ileostomy Category: Gastrointestinal Gastrectomy: Antrectomy Hemigastrectomy Subtotal / Total Category: General Gastrectomy: Antrectomy Hemigastrectomy Subtotal Total Category: Gastrointestinal

Gastroduodenostomy Category: General Gastroduodenostomy (Moved to second group) Category: Gastrointestinal

Gastroenterostomy Category: General Gastroenterostomy (Moved to second group) Category: Gastrointestinal

Gastrojejunostomy

Category: General Gastrojejunostomy (Moved to second group) Category: Skin / Connective Tissue

Mastectomy Category: General Mastectomy: (Excludes Lumpectomy) Modified Radical (MRM)

Partial, +/-Axillary Dissection Prophylactic: Total / Simple Radical

Total / Simple Category: Gastrointestinal

Pancreatectomy Category: General Pancreatectomy: Subtotal Total

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2009 Category & Procedure Name 2010 Category & Procedure Name

Pancreatic Pseudocyst Drainage / Pancreatocystogastrostomy / Pancreatocystojejunostomy

Category: General

Pancreatic Pseudocyst, Laparotomy and Drainage

Pancreatocystogastrostomy Pancreatocystojejunostomy Category: Gastrointestinal

Small Bowel Resection / Repair Category: General Small Bowel Resection Category: Endocrine

Thyroidectomy Category: General Thyroidectomy: Partial

Total Category: Skin / Connective Tissue

Burn: Escharotomy / Excision / Debridement / Grafting

Category: Hand, Plastic, & Reconstruction Burn, Excision, +/- Graft:

Full Thickness (3rd degree)

Deep Partial Thickness (2nd degree) Category: Skin / Connective Tissue

Burn: Escharotomy / Excision / Debridement / Grafting

Category: Hand, Plastic, & Reconstruction Escharotomy (3rd_{degree Burn)}

Category: Skin / Connective Tissue Incision and Drainage (I & D), Infection,

Hand / Digit

Category: Hand, Plastic, & Reconstruction Incision & Drainage, Infection, Hand / Digit:

High Pressure Injection Injury Septic Joint

Suppurative Flexor Tenosynovitis Category: Skin / Connective Tissue

Muscle / Skin / Fascia Flap, Local Category: Hand, Plastic, & Reconstruction Muscle Flap, +/- Skin Flap Category: Nervous System

Burr Holes / Twist Drill Holes Category: Neurologic & Spine Craniectomy / Burr Holes Category: Nervous System

Craniectomy / Craniotomy Removal / Repair, AVM

Category: Neurologic & Spine Craniotomy:

Arteriovenous Malformation (AVM) Removal

Brain Tumor Excision

Intracranial Aneurysm Clipping:

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Nervous System CSF Shunt: Revision*; Insertion Ventriculostomy

V-P Shunt / Ventriculocisternostomy (Torkildsen) Insertion / Revision

Category: Neurologic & Spine Cerebral Spinal Fluid Shunt:

Internal Shunt, Third Ventriculostomy / Revision

Lumbar Peritoneal Ventriculostomy / Revision

Torkildsen Ventriculo-Cisternostomy / Revision

Ventriculoatrial Shunt Insertion / Revision

Ventriculojugular Shunt Insertion / Revision

Ventriculoperitoneal Shunt Insertion / Revision

Ventriculopleural Shunt Insertion / Revision

Category: Musculoskeletal

Discectomy: Anterior Cervical, +/- Fusion; Lumbar; Temporomandibular Joint

Category: Neurologic & Spine

Discectomy and Fusion, Anterior Cervical:

Vertebral Corpectomy and Fusion, Cervical

Discectomy, Herniated Lumbar Intervertebral Disc* (Moved to second group) Category: Musculoskeletal

Excision:

Herniated Lumbar Intervertebral Disc

Metastatic Tumor, Spine, +/- Stabilization

Radial Head (Avascular Necrosis), Elbow (Open)

Radial Head (Intra-articular Fracture), Elbow (Open)

Category: Neurologic & Spine Discectomy, Herniated Lumbar

Intervertebral Disc* (Moved to second group)

Metastatic Tumor Excision, Spine, +/- Fusion

Fusion: Cervical Spine; Lumbar Spine; Spinal with Harrington Rod; Thoracic Spine

Category: Neurologic & Spine Fusion:

Arthrodesis, Spine

Cervical Spine Lumbar Spine Thoracic Spine

(Harrington Rod procedures are located in the second group)

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Nervous System Laminectomy and Disc Excision,

Transpedicular

Laminectomy, +/- Discectomy, +/- Foraminotomy: Cervical; Thoracic; Lumbar; Sacral

Category: Neurologic & Spine Laminectomy, +/- Discectomy, +/- Foraminotomy: Cervical: Laminoplasty, Cervical Lumbar Thoracic:

Anterior Discectomy, Thoracic Costotransversectomy and Disc

Excision, Thoracic

Transpedicular Laminectomy and Disc Excision, Thoracic Transthoracic Disc Excision, via

Thoracotomy

Laminectomy, +/- Foraminotomy, Sacral (Moved to second group)

Category: Musculoskeletal ORIF: Odontoid

Category: Neurologic & Spine ORIF, Odontoid

(Moved to second group)

Osteotomy, Spine Category: Neurologic & Spine Osteotomy, Spine (Moved to second group) Category: Nervous System

Spinal Fusion / Arthrodesis of Spine Category: Neurologic & Spine Fusion:

Arthrodesis, Spine

Cervical Spine Lumbar Spine Thoracic Spine Category: Nervous System

Stereotactic Lesion Creation: Globus Pallidus; Subcortical; Thalamus

Category: Neurologic & Spine Stereotactic Lesion Creation:

Pallidotomy, Unilateral Subthalamotomy Thalamotomy

Category: Nervous System

Thrombolysis / Embolization, Cerebral Category: Neurologic & Spine Cerebral Embolization Cerebral Thrombolysis

Category: Nervous System

V-P Shunt / Ventriculocisternostomy (Torkildsen) Repair / Replace / Remove

Category: Neurologic & Spine V-P Shunt / Ventriculocisternostomy (Torkildsen) Repair* / Replace / Remove*

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Obstetric / Gynecologic Cervical Cerclage (McDonald / Shirodkar), Emergent

Category: Obstetric / Gynecologic Cervical Cerclage, Emergent Category: Obstetric / Gynecologic

Colporrhaphy: Deep Repair; Superficial Repair*

Category: Obstetric / Gynecologic Colporrhaphy, Anterior:

Cystocele Repair

Colporrhaphy, Posterior:

Rectocele Repair

(Moved to first group) Category: Obstetric / Gynecologic

Hysterectomy

Category: Obstetric / Gynecologic Hysterectomy:

Abdominal, +/- BSO

Laparoscopically Assisted Vaginal (LAVH), +/- BSO

Radical

Supracervical, +/- BSO (Open) Vaginal, +/- BSO

Category: Obstetric / Gynecologic

Pubovaginal Sling Category: Obstetric / Gynecologic Pubovaginal Sling* (Moved to second group)

Category: Obstetric / Gynecologic

Vulvectomy: Radical / Hemivulvectomy Category: Obstetric / Gynecologic Hemivulvectomy Vulvectomy, Radical

Category: Eye, Ear, Nose, Throat

Anastomosis, Facial Nerve, Hypoglossal Category:

Otolaryngology

Oro

‐

Maxillo

‐

Facial

&

Anastomosis, Facial Nerve, Hypoglossal (Moved to second group)

Discectomy: Anterior Cervical, +/- Fusion; Lumbar; Temporomandibular Joint

Category:

Oro

‐

Maxillo

‐

Facial

&

Otolaryngology

Temporomandibular Joint (TMJ): Arthroplasty

Discectomy Reconstruction Category: Eye, Ear, Nose, Throat

Glossectomy Category:

Otolaryngology

Oro

‐

Maxillo

‐

Facial

&

Glossectomy, Partial

Nasal / Sinus (Surgical Open procedure) Category: Oro

Otolaryngology

‐

Maxillo

‐

Facial

&

Ethmoidectomy (Open)

Frontal Sinus Obliteration

Oronasal Fistula Repair with Bone Grafting Sinusotomy, Frontal (Open)

Sialoadenectomy* Category:

Otolaryngology

Oro

‐

Maxillo

‐

Facial

&

Sialoadenectomy*

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2009 Category & Procedure Name 2010 Category & Procedure Name

Bone Graft: Fibula Category: Orthopedic, Upper & Lower _Extremity Bone Graft, Fracture Malunion or Nonunion:

Implantable Stimulator

Long Bones (e.g., Humerus, Radius, Ulna, Femur, Tibia, Fibula)

Category: Musculoskeletal Excision:

Herniated Lumbar Intervertebral Disc

Metastatic Tumor, Spine, +/- Stabilization

Radial Head (Avascular Necrosis), Elbow (Open)

Radial Head (Intra-articular Fracture), Elbow (Open)

Category: Orthopedic, Upper Extremity Arthrotomy:

Elbow:

Avascular Necrosis (Osteonecrosis) of Radial Head

Contracture Release Intra-articular Fracture

Lavage for Joint Infection Category: Orthopedic, Upper Extremity_{Lavage for (+) Joint Infection} (Found within Arthroscopy and Arthrotomy indications)

Olecranon Fracture Repair, Elbow (Open)

Category: Orthopedic, Upper Extremity Open Reduction and Internal / External

Fixation, Distal Radius +/- Ulna

Distal Radius +/- Ulna Styloid, External Fixator

ORIF, Distal Radius ORIF, Ulna Styloid

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2009 Category & Procedure Name 2010 Category & Procedure Name

ORIF: Humeral Shaft; Distal Radius +/- Ulna

Category: Orthopedic, Upper Extremity Open Reduction and Internal / External Fixation, Distal Radius +/- Ulna:

Distal Radius +/- Ulna Styloid, External Fixator

ORIF, Distal Radius ORIF, Ulna Styloid

Reduction and Fixation, Shaft Fracture: Humeral Shaft

Humeral Shaft Plate

Humeral Shaft Intramedullary Device ORIF, Humeral Shaft

Humeral Shaft External Fixator

Radius +/- Ulna Shaft

ORIF, Radius and Ulna Shaft

Radius +/- Ulna Shaft Intramedullary Device

Radius +/- Ulna Shaft Plate Radius +/- Ulna Shaft External

Fixator

Total Joint Replacement: Elbow; Ankle; Wrist*

Category: Orthopedic, Upper Extremity Arthroplasty:

Elbow Wrist

(Moved to first group) Category: Musculoskeletal

Capsulotomy (Contracture Release): Hip; Knee (Open)

Category: Orthopedic, Lower Extremity Arthrotomy: Hip: Contracture release Knee: Contracture release Category: Musculoskeletal

Lavage for Joint Infection

Category: Orthopedic, Lower Extremity Lavage for (+) Joint Infection

(Found within Arthroscopy and Arthrotomy indications)

ORIF: Acetabulum; Ankle; Femoral Neck; Pelvis

Category: Orthopedic, Lower Extremity ORIF: Acetabulum Ankle Calcaneal Femoral Neck Knee Pelvis

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2009 Category & Procedure Name 2010 Category & Procedure Name

ORIF: Femoral Shaft; Hip (Proximal Femur); Tibial Shaft

Category: Orthopedic, Lower Extremity Reduction and Fixation, Shaft / Hip

Fracture: Femoral Shaft:

Femoral Shaft Intramedullary Device

Femoral Shaft Plate ORIF, Femoral Shaft

Femoral Shaft External Fixator

Hip (Proximal Femur):

Hip Intramedullary Device Hip Plate

ORIF, Hip (Proximal Femur)

Tibial Shaft:

ORIF, Tibial Shaft

Tibial Shaft External Fixator Tibial Shaft Intramedullary Device Tibial Shaft Plate

Category: Musculoskeletal Patellar Fracture Repair

Category: Orthopedic, Lower Ex tremity

Patellar Fracture Repair* (Moved to second group) Category: Musculoskeletal

Patellar Tendon Rupture Repair Category: Lower Extremity _{Patellar Tendon Rupture Repair*} (Moved to second group)

Quadricepsplasty (Release Procedure), Knee (Open)

Category: Orthopedic, Lower Extremity Arthrotomy:

Knee:

Quadricepsplasty Category: Musculoskeletal

Total Joint Replacement: Elbow; Ankle; Wrist*

Category: Orthopedic, Lower Extremity Total Joint Replacement: Ankle

Appendectomy: (Open / Perforated / Complicated) Category: Pediatric Appendectomy: Complicated Laparoscopic Open Perforated

Herniorrhaphy, Ventral / Incisional:

Category: Pediatric

Herniorrhaphy, Ventral / Incisional / Epigastric:

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Genitourinary

Cystectomy Category: Urology Cystectomy: Partial

Radical Simple Category: Genitourinary

Ileal Conduit Category: Urology Urinary Diversion, Intestinal Conduit Category: Genitourinary

Nephrectomy: Partial; Radical; Simple; Total; Donor

Category: Urology Nephrectomy:

Partial Radical

Simple (Includes Total) Nephrectomy:

Donor

(Moved to second group) Category: Genitourinary

Prostatectomy: Open

Transurethral*

Transurethral Holmium Laser Resection / Enucleation Radical

Category: Urology Prostatectomy:

Open

Radical (Robotic-Assisted Radical Prostatectomy)

Category: Genitourinary

Urethropexy Category: Urology Urethropexy*

(Moved to second group) Category: Vascular

Aorto-Celiac Repair, +/- Graft / +/- Bypass

Aorto-Mesenteric Repair, +/- Graft / +/- Bypass

Category: Vascular

Aorto-Celiac / Aorto-Mesenteric Repair, +/- Graft:

Aorto-Celiac / Aorto-Mesenteric Endarterectomy

Category: Vascular

Bypass Insertion / Revision / Repair / +/- Graft: Proximal (e.g., Aorto-Femoral); Distal (e.g., Femoro-Popliteal)

Category: Vascular

Bypass, Distal, Peripheral Artery:

Femoro-Pedal Femoro-Popliteal Femoro-Tibial Popliteal-Pedal Popliteal-Tibial

Bypass, Proximal, Peripheral Artery:

Aorto-Femoral Aorto-Iliac Axillo-Bifemoral Axillo-Femoral Femoral-Femoral Ilio-Femoral

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2009 Category & Procedure Name 2010 Category & Procedure Name

Category: Vascular

Embolectomy / Thrombectomy: Celiac Artery

Superior Mesenteric Artery

Category: Vascular Embolectomy: Celiac Artery Mesenteric Artery Thrombectomy: Celiac Artery Mesenteric Artery (Moved to second group) Category: Vascular

Endovascular Intervention, Peripheral Artery*

Category: Vascular

Endovascular Intervention, Peripheral Artery:

Angioplasty, Peripheral Artery Atherectomy, Peripheral Artery Stent, Peripheral Artery

Urgent

Planned anticoagulation Kidney failure

Category: Vascular

Subfascial Ligation, Perforating Veins* Category: Vascular Subfascial Ligation, Perforating Veins:

Linton Procedure

Open Category: Vascular

Repair, A-V Aneurysm; Blood Vessel (Intra-abdominal / Intrathoracic only)

Category: Vascular

Repair, Intra-abdominal / Intrathoracic: A-V Aneurysm

Blood Vessel Category: Vascular

Venous Valve Reconstruction Category: Vascular Venous Valve Reconstruction (Moved to first group)

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